Hot Topics – 11/04/2015

FRAUD/ABUSE

South Carolina Hospital To Pay $237 Million to Resolve False Claims Act Violations: Tuomey Healthcare System, a SC hospital, is to pay $237 million for violations of the False Claims Act and Stark Law. In May 2013, a jury found that Tuomey violated the Stark Law by illegally billing Medicare for services referred by physicians with whom the hospital had an improper financial relationship. According to the U.S. Department of Justice news release, “Tuomey, fearing that it could lose lucrative outpatient procedure referrals to a new freestanding surgery center, entered into contracts with 19 specialist physicians that required the physicians to refer their outpatient procedures to Tuomey and, in exchange, paid them compensation that far exceeded fair market value.” According to the news release, the government also argues that Tuomey ignored and suppressed warnings from one of its attorneys that the physician contracts were “risky” and raised “red flags.” Under the settlement, Tuomey is to enter into a five year Corporate Integrity Agreement which will require any physician arrangements to be reviewed by an independent organization. For more information, visit http://www.justice.gov/opa/pr/united-states-resolves-237-million-false-claims-act-judgment-against-south-carolina-hospital